The Role of Pelvic Ultrasound in Preoperative Evaluation for Laparoscopic Myomectomy

Study Objective: To determine the accuracy of pelvic ultrasonography (US) in preoperative evaluation before laparoscopic myomectomy. Design: A prospective cohort study (Canadian Task Force classification II-2). Setting: A tertiary level referral center of minimally invasive gynecologic surgery, Sant'Orsola University Hospital, Bologna, Italy. Patients: One hundred one of the 125 women undergoing laparoscopic myomectomy from September 2015 to May 2016 were included. Interventions: Preoperative pelvic US was performed 2 weeks before surgery. Measurements and Main Results: Among the 101 women enrolled in this study, preoperative US correctly identified the number of myomas in 73 patients (72.3%). A total of 208 myomas were preoperatively identified by US; 197 (94.7%) were surgically removed, and 11 (5.3%) were not visualized during laparoscopic myomectomy. The 11 undetected myomas were intramural (International Federation of Gynecology and Obstetrics [FIGO] type 3 and 4), with a mean diameter of 19.05 ± 5.91 mm. The type, site, and location of the 197 myomas identified by US preoperatively and removed via laparoscopy were confirmed at surgery in 78.7% (155/197), 80.7% (159/197), and 84.3% (166/197) of the cases, respectively. Two-hundred fifty-four total myomas were removed laparoscopically; 197 (77.6%) were preoperatively identified by US, and 57 (22.4%) were missed by US, having had a mean diameter of 13.51 ± 7.84 mm and predominantly being the subserosal type (FIGO type 5, 6, and 7) (57.9%, p < .05). Conclusion: Pelvic US is a valuable tool in preoperative evaluation and should be systematically performed when planning laparoscopic myomectomy.